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Communication skills training is now internationally accepted as an essential component of medical education. However, learners and teachers in communication skills programs continue to experience problems integrating communication with other clinical skills, ensuring that clinical faculty support and teach communication beyond the formal communication course, extending communication training coherently into clerkship and residency, and applying communication skills in medical practice at a professional level of competence. One factor contributing to these problems is that learners confront two apparently conflicting models of the medical interview: a communication model describing the process of the interview and the "traditional medical history" describing the content of the interview. The resulting confusion exacerbates the above dilemmas and interferes with learners using communication skills training to advantage in real-life practice. The authors propose a comprehensive clinical method that explicitly integrates traditional clinical method with effective communication skills. To implement this more comprehensive approach, they have modified their own Calgary-Cambridge guides to the medical interview by developing three diagrams that visually and conceptually improve the way communication skills teaching is introduced and that place communication process skills within a comprehensive clinical method; devising a content guide for medical interviewing that is more closely aligned with the structure and process skills used in communication skills training; and incorporating patient-centered medicine into both process and content aspects of the medical interview. These enhancements help resolve ongoing difficulties associated with both teaching communication skills and applying them effectively in medical practice.

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A study of women's views on carrying their medical records during their pregnancy was conducted in Cambridge in 1982.Eighty eight women who were given their fuli records were compared with a control group of 83 women who carried the traditional cooperation card, both groups answering postal questionnaires about the advantages and disadvantages of carrying the-ir respective records. Most women found advantages in carrying the complete record, although it was too large to carry for practical purposes. Both groups experienced difficulty in understanding what was written on their cards. IntroductionMost women in Britain carry the familiar cooperation card with them during pregnancy, on which medical staffrecord details of the pregnancy. This card has been criticised: the space on it is limited, and results of investigations may not be recorded. A few maternity units have given women the main hospital antenatal record to carry throughout pregnancy, and they reported it as successful, although no control group was incorporated in their studies."'3 We therefore studied women's views on carrying their complete record and compared them with views of a control group of women receiving traditional antenatal care.

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